Today, the Explorers and I are proud to announce that we’ve received a grant from the London-based Guy’s and St Thomas’ Charity (GSTC). The award of £20,000 will go towards exploring whether there is enough thinking and doing out there to warrant a conference on ‘creating health’.

Over the next four months I will be getting guidance from the Explorers and meeting with people on three broad areas:

1. Understanding and valuing health in ways other than the deficit model 2. Finding real-world examples of health creation, including the value models used 3. Hearing the perspective of funders, especially on how they justify the investment

If you have a perspective to share, we’d love to hear from you. Above is the one-pager (PDF) we’ve created with the Charity to explain the project.

So much has happened in the world of Wellthcare I don’t know where to start. I’m a reductionist at heart so let’s start with a number – 20. This is the percentage that health care contributes to our health, according to Nancy Adler of the University of California, San Francisco. She was writing for ‘Investing in what works for American communities’, a project that calls on leaders from the public, private, and non-profit sectors to build on what we know is working to move the needle on poverty. It’s worth taking a moment to reflect on that number. It’s small. And yet when you read about health, whether it’s in the mainstream media, academic journals or the effervescent health innovation scene, what you’re really reading about is health care. It’s very rare to read about health creation. I’m saying this a lot these days and am always countered with the idea of prevention. There are two reasons why I am reserved about prevention.

Our first example of Wellthcare leveraged the local postal service to create new, health-related value. It was able to do so because the people involved knew their postal worker – they were part of the local community. Our second example – GeriJoy – uses the emerging digital infrastructure to sidestep the geographic constraints inherent to using something as ‘local’ as a postal system. In doing so, it enables us to reimagine ‘community’. I was lucky enough to meet its CEO, Victor Wang, when he spoke at TEDMED 2013. His talk made me see the world differently, and made me realise that by doing so we can find new forms of health-related value. Pritpal S Tamber: Hi Victor, so tell us about what you’re doing. Victor Wang: We provide virtual companions for the elderly in the form of adorable, talking pets that live inside tablets. They’re actually avatars for our staff that work behind the scenes 24/7. Our staff share family photos, positive memories, and things like that; in essence, we provide seniors with personalised, intelligent and compassionate companionship.

Twenty-thirteen was an important year, partly because of Angelina Jolie’s breasts and what they meant for 'standard' care and partly because of emerging discussions around ‘value’. Where 2013 failed to deliver was in delivering acceptance around failure, but more on that, including why it matters, at the end. You’ll likely recall that in May Angelia Jolie, the actress and director, wrote an op-ed in the New York Times about her decision to have a double mastectomy in response to her genetically-defined 87% risk of breast cancer. She described her decision as “preventative” and ended her piece saying:

"Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of."

When I reflected on this with Scott Liebman, one of the Wellthcare Explorers, he told me of a friend with breast cancer – let’s call her Jane – who had decided not to have a mastectomy or chemotherapy (both of which were recommended by her doctor), but to have a lumpectomy. Jane’s version of taking control was to prioritise quality time with her grandchildren rather than spend months delaying the inevitable and feeling iatrogenically rotten.

Today, we’re publishing the third Despatch from the Wellthcare Explorers. In it we discuss the importance of people’s context, largely because it came up so many times in the second Despatch when we discussed wants and needs. I also wanted to tie the idea of context to resilience and ‘asset-based health’, the latter being convincingly described by the Glasgow Centre for Population Health (see the PDF of their 2011 report). At the end of this post is the Summary, succinctly delivered by the ever-impressive Wellthcare Correspondent, Leigh Carroll.

The exploration being reported on in this third Despatch happened at the beginning of December but the report has been delayed by my recent trip to the US during which I was prospecting for Wellth (see the related Log post). This has given me a chance to reflect further on the discussion.We’ve always been open about the fact that we’re searching for Wellth, part of the process being that we’ll refine our definition as we go (the last refinement was described in this Log post). At the time of the discussion the definition was: “new, health-related value, defined by what people want to do, supported by their nano-networks”. The italicised bit was based on the belief that our behaviours are most influenced by our closest friends but we also need to recognise that their closest friends also influence them. That likely means that ‘support’ happens at two levels (at least) – one’s nano-network and one’s broader community.

I'm writing this post on the plane back from the US; Dulles to Heathrow, my mind overflowing with the thoughts of the many I have met in the past three weeks. I thought I'd jot down my strongest memories, as much a challenge to myself as possible food for our thoughts. Perhaps my favourite sound bite was "middle-out". The impressive John Vu of Kaiser Permanente offered it as we discussed how to engage communities in order to activate their assets and build resilience. I have long worried that medicine - and especially public health - is a top-down, patriarchal, almost condescending profession. At the same time, given how complicated health care is it's hard to see it ever becoming bottom-up. John said that Kaiser is experimenting with what he describes as "middle-out" ways to engage with local communities. Fascinating.

The inimitable Zubin Damania

I got a glimpse of a real community at an evening Q&A with the inimitable Zubin Damania of Turntable Health, a new primary care service being developed in Las Vegas aided by the ever-impressive Iora Health. It was interesting to hear their questions, many of which betrayed the sheer confusion around the Affordable Care Act (ACA). Damania was both eloquent and informative in his responses, if not downright reassuring that everything will be all right. Despite the sheer size and complexity of the ACA I was left feeling that with new thinkers like Damania at the helm (ably supported by the Regional Medical Director of Iora Health, Anjali Taneja) the US may well learn how to deliver a more equitable form of health care.

This is the most common request we get at Wellthcare, the most recent being over lunch in Manhattan. I was dining with Scott Liebman, one of the Wellthcare Explorers, and his friend wanted a concrete example. I replied with my favourite example, Jersey Post’s recently launched ‘Call & Check’ service and today we’re lucky enough to be sharing an interview with its founder, Joe Dickinson.

MedCrunch: So, Joe, tell me about the proposed service of ‘Call & Check’?

Joe: It was based on the needs of a rapidly aging population and how a postal operator could help in the community's jigsaw. It’s a very simple idea. The postal guy, who visits everyday, will knock on the door and ask, "How are you?" and just check and see how they are that day, and give a little bit of social interaction for five or six minutes. If they require things from the community, be it medical or social, the postal guy could then link them back to the right people.

I’m writing this Log post from Las Vegas, USA, where I have come to experience the Downtown Project, an attempt to transform the downtown area into the most community-focused large city in the world. I think it’ll take me a few days to digest what I am learning but its community focus very much reminds me of a story that lit the touch paper on Wellthcare and I thought I’d share it. Richard Smith, the Director of United Health Group’s Chronic Disease Initiative and the former Editor-in-Chief of the BMJ shared the story as a blog post. In essence, his mother has no short-term memory and he was asking, “How much have the health and social services helped my mother?” I encourage you to read the full post but this series of excerpt gives you a flavour of what he and his family were dealing with:

As patients become more sophisticated purchasers of health care, they will push competition in health care delivery to look increasingly like that in consumer-goods industries. This competition could lead to product offerings that appeal to consumers with different needs. While some patients may seek greater odds of survival, others may seek a faster return to work or lower out-of-pocket costs. These options are at the core of “patient-centered” care.

This is the wantified self, as described through medical parlance. It's an idea whose time has clearly come.

The article's focus is on how information about hospital performance needs to be more communicative for people to be able to use it. I'd argue that, although this is needed, what we really need is to go upstream and first understand what it is that people are trying to do in their lives. It's through this deeper "wantification" can we - people, communities, and their health care providers - work together to help people be healthy in ways that they define.

The final paragraph also touches on an area that we've been discussing in exploration: